Discontinuation of Children’s Home and Community Based Services (HCBS) Day Habilitation Service
IMPACTED PLANS: Medicaid, HIV SNP, CHP
TO: HCBS Day Habilitation Providers
Effective January 1, 2026, Children’s HCBS Day Habilitation will no longer be a covered service under the Children’s Waiver. The NYS DOH submitted a waiver amendment to CMS removing Day Habilitation as a covered service. Members who are receiving Day Habilitation services or have been referred for Day Habilitation services will be referred to a Community Habilitation provider to provide the same type of service as Day Habilitation in a less restrictive environment no later than March 1, 2026.
Care managers serving members currently in receipt of or referred to Day Habilitation through the Children’s Waiver must connect with members/families to discuss this update. If it is determined that the participant has a continued need for support with Activities of Daily Living (ADL)/Instrumental Activities of Daily Living (IADL) skill development, the member can be referred to a Children’s Waiver Community Habilitation provider for continued support in these areas. Additionally, care managers should not refer new members to Day Habilitation and explain that Community Habilitation can serve the members in the same manner to meet their ADL/IADL skill development needs.
Care managers, HCBS providers, and MetroPlusHealth will have until March 1, 2026, to ensure that members are transitioned to a Community Habilitation. Care managers will coordinate with members and families and designated Day Habilitation service providers to complete referrals for impacted members and update the members’ plan of care.
Authorization requests for new Community Habilitation services for members transitioning from Day Habilitation to Community Habilitation as a result of this Waiver update must be submitted by March 1, 2026. Day Habilitation claims with dates of service on or after March 1, 2026, will not be paid.
Note: Agencies currently designated to provide Day Habilitation under the Children’s Waiver will receive a formal de-designation letter with an effective de-designation date on or after March 1, 2026.
MetroPlusHealth will configure their systems to reflect this update and collaborate with all participating agencies to prevent any potential service disruptions.
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected].